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surgery > Common Head and Neck Surgeries > Flashcards

Common Head and Neck Surgeries Flashcards

1
Q

What is a tonsillectomy?

A

Procedure in which both palatine tonsils are fully removed from the back of the throat

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2
Q

What is a adenoidectomy?

A

Surgical removal of the adenoids, one of the most common surgical procedures in kids

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3
Q

What are adenoids?

A

Patch of lymphoid tissue that sits at back of nasal passage
Trap harmful bacteria and viruses that we breathe in or swallow

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4
Q

Indications for tonsillectomy (+/- adenoidectomy) in a pediatric patient

A

OSA first-line treatment
Recurrent throat infections if >7 in 1 year, >5 in each of 2 years of >3 in each of 3 years
Peritonsillar abscess

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5
Q

What is a grade 0 tonsil grade? 4?

A

0: not visible beyond anterior tonsillar pillar/surgically removed; IV: tonsils meet at midline “kissing tonsils”

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6
Q

What does OSA lead to?

A

Cardiovascular and cognitive comorbidities

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7
Q

COmplications of peritonsillar abscess

A

Airway obstruction
Recurrent infection

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8
Q

Indications for adenoidectomy in pediatric patient

A

Nasal obstruction due to adenoid hypertrophy with OSA
Chronic sinusitis
Recurrent otitis media with h/o tubes

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9
Q

Contraindications to tonsillectomy/adenoidectomy

A

Cleft palate
Coagulopathies/anemia
Active infection

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10
Q

Diagnosis of T&A surgical need?

A

Clinical assessment demonstrating recurrent infections
Sleep study + OSA

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11
Q

What most commonly causes peritonsillar abscess?

A

Group B strep

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12
Q

Tracheostomy indications

A

For patients who are unable to wean from invasive ventilation within 1-3 weeks of intubation
Critically ill patients or medically induced coma

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13
Q

What are benefits of percutaneous tracheostomy?

A

Less time to perform
Less expensive
Can be done sooner

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14
Q

Who performs a percutaneous tracheostomy?

A

Surgeon
Interventional pulmonologist
Trained critical care clinician

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15
Q

What is the risk of percutaneous tracheostomy

A

greater risk for tracheal injury

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16
Q

Contraindications (relative) of trach?

A

<15 yo
Uncorrectable bleeding diathesis
Gross distortion of neck due to hematoma, tumor, thyromegaly, or scarring
Infection

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17
Q

Benefits of trach

A

Comfort: need for pain meds and sedation decrease
Weaning from ventilation

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18
Q

Early complications of a trach

A

Obstruction: more common in percutaneous d/t posterior wall membranes of the trachea
SubQ emphysema/pneumothorax: 1%

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19
Q

Late complications of trach

A

Tracheal stenosis and malacia: formation of granulation tissue
Tracheoarterial fistula
Reduced phonation

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20
Q

What is the most devastating complciation of trach? What happens?

A

Tracheoarterial fistula
Erosion of the tracheal tube through anterior wall forming fistula communicating with innominate artery

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21
Q

When are tracheostomy tubes changed?

A

Initially at 7-14 days s/p insertion then every 30-90 days

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22
Q

What additional factors should cause you to change trach tube?

A

Patient has discomfort
Malposition
Patient-ventilator asynchrony
Cuff leak
Fracture of tube
Need for bronchoscopy

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23
Q

What criteria must be met in order to decannulate

A

Weaned from mechanical ventilation
No upper airway obstruction
Clear their own secretions that are neither copious or too thick
Have an effective cough

24
Q

What is failed decannulation associated with?

A

Age
Greater severity of illness
Renal failure
Shorter duration of spontaneous breathing prior to decannulation

25
Q

What is the process of decannulation?

A

1) Tube downsizing and capping trial in hospital or ENT office
2) removal of tube: stroma covered with occlusive dressing and observation for 24-48 hours
3) closing the stroma

26
Q

When is capping not done unless in ICU or in medically ordered polysomnogram?

A

during sleep

27
Q

How is stoma closed?

A

tracheocutaneous fistula (open tract between skin and trachea) covered with bandage until fully closed
bandage replaced daily or more frequently if it becomes saturated

28
Q

what are causes of thyroid nodules?

A

Thyroid adenoma
thyroid cyst
hashimoto’s disease
multinodular goiter
iodine deficiency
cancer

29
Q

what is a thyroid adenoma?

A

benign overgrowth of tissue

30
Q

what is a thyroid cyst

A

results from degenerating adenomas
usually benign but can contain solid cancerous tissue

31
Q

what is hashimotos disease

A

chronic inflammation

32
Q

what causes a multinodular goiter

A

iodine deficiency or thyroid disorder

33
Q

what are characteristics of thyroid cancer?

A

Hard, large, painful or non-painful mass

34
Q

What increases risk of thyroid mass malignancy?

A

1) Children, adults <30 or >60
2) h/o head and neck irradiation
3) family h/o thyroid CA

35
Q

diagnosis of thyroidectomy need

A

physical exam revealing enlarged thyroid or thyroid mass
If TSH subnormal-hyperfunctioning thyroid
If TSH elevated - hypofunctioning
U/S to determine extent of nodule/mass and if there are multiple nodules
FNA- cytology results determine if benign or malignant and need for surgery
Thyroid scintigraphy

36
Q

What is the purpose of thyroid scintigraphy?

A

Determines function of nodule by injecting radioactive contrast dye
Hyperfunctioning nodules are rarely malignant “hot”
“cold” hypofunctioning areas are more likely to be malignant

37
Q

what are the primary thyroid cancers?

A

papillary (MC)
follicular
anaplastic (most agressive but not common)

38
Q

What are secondary forms of thyroid cancers

A

Thyroid lymphoma
Medullary cancers (a part of MEN type 2)
Metastatic

39
Q

Treatment for thyroid cancer

A

Total thyroidectomy
Lobectomy

40
Q

When would a total thyroidectomy be performed?

A

Multifocal nodules
Nodule >1 cm
Nodule that extends across isthmus
Metastatic or anaplastic

41
Q

When could a lobectomy be performed?

A

Single nodule <1 cm

42
Q

Complications of thyroidectomy

A

Recurrent laryngeal nerve injury –> vocal cord paralysis
Resection of parathyroids –> hypocalcemia –> muscle spasms, tetany, dementia, seizures, Chvostek and Trousseaus sign
Hypothyroidism

43
Q

Postoperative management of thyroidectomy

A

Monitor voice
Check serum calcium levels
Start on levothyroxine

44
Q

Indications for parotidectomy

A

Blockage of parotid duct d/t stone or mass
Parotid mass or tumor

45
Q

Diagnosis of parotidectomy

A

Enlargement of the parotid gland
Can start with US but is limited by sonographer experience
CT with contrast first line imaging/MRI if concerned for malignancy or vascular tumor

46
Q

Complications of parotidecomy

A

Facial nerve paralysis
Seroma
Hematoma
Wound infection

47
Q

What is a carotid endarterectomy?

A

Procedure to remove build-up of fatty deposits, which cause narrowing of a carotid artery

48
Q

Indications of need for carotid endarterectomy

A

Carotid stenosis, symptomatic or asymptomatic

49
Q

Diagnosis of need for carotid endarterectomy

A

Physical exam with auscultation of carotids
US is initial screening
Angiography as gold standard
CTA/MRA

50
Q

Indications for surgery via carotid endarterectomy

A

70-99% stenosis of carotid artery
Patient >5 year life expectancy who medically qualifies

51
Q

Where is a carotid artery blockage most common?

A

At bifurcation

52
Q

Contraindications to carotid endarterectomy

A

Absolute: asymptomatic complete occlusion of the carotid artery
Relative: h/o neck irradiation, tracheostomy, h/o radical neck dissection, unacceptably high medical risk

53
Q

Preop preparation for carotid endarterectomy

A

ASA 81 mg
Statins
Often admitted for BP and heart monitoring prior, preop antibiotics

54
Q

Complications of carotid endarterectomy

A

CVA (30 day p/o rates of .25-3%: ischemia –> plaque emoli –> platelet aggregates
MI (MC)
cerebral hyperperfusion
nerve injury (hypoglossal, vagus, facial branches, ansa cervicalis, recurrent laryngeal)
Hematoma

55
Q

Postop care after carotid endarterectomy

A

Admit to telemetry or ICU
Neuro checks every hour
BP checks every 2 hours: systolic BP b/t 100-150
Continue aspirin and statins
Typically inpatient for 3-5 days
Follow up in 3-6 weeks for U/S

surgery (7 decks)

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